Bhatt Himani, Wei Benjamin
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham Medical Center, Birmingham VA Medical Center, Birmingham, AL, USA.
J Thorac Dis. 2023 Mar 31;15(3):1494-1502. doi: 10.21037/jtd-22-819. Epub 2023 Feb 16.
In both clinical practice and residency training, the use of robotic platforms in surgery is becoming more common. The aim of this study was to perform a systematic review of the perioperative outcomes of robotic and laparoscopic paraesophageal hernia (PEH) repair.
The PRISMA statement guidelines were used to perform this systematic review. We conducted a database search which included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. There were 384 articles discovered in the initial search using various keywords. From those 384 articles, after duplicates were removed and publications were eliminated based on eligibility criteria, 7 publications were then chosen for analysis. Risk of bias was assessed using Cochrane Risk of Bias Assessment Tool. Narrative synthesis of results has been provided.
When compared to standard laparoscopic approaches, robotic surgery for large PEHs may offer benefits in terms of decreased conversion rate and shorter hospital stay. Some studies found a decrease in need for esophageal lengthening procedures and fewer long-term recurrences. The perioperative complication rate is similar between the two techniques in most studies; however, one large study of nearly 170,000 patients in the early years of robotics adoption demonstrated a higher rate of esophageal perforation and respiratory failure in the robotic group (2.2% increase in absolute risk). Cost is another disadvantage of robotic repair when compared to laparoscopic repair. Our study is limited by the non-randomized and retrospective nature of the studies.
More studies into recurrence rates and long-term complications are needed to determine the efficacy of robotic versus laparoscopic PEHs repair.
在临床实践和住院医师培训中，手术中使用机器人平台正变得越来越普遍。本研究的目的是对机器人辅助和腹腔镜下食管旁疝（PEH）修补术的围手术期结果进行系统评价。
采用PRISMA声明指南进行本系统评价。我们进行了数据库检索，包括Ovid MEDLINE（R）及印刷版之前的Epub、在研及其他未编入索引的文献以及每日更新文献、Ovid EMBASE、Ovid Cochrane对照试验中心注册库、Ovid Cochrane系统评价数据库和Scopus。在初始检索中使用各种关键词共发现384篇文章。在去除重复文章并根据纳入标准排除出版物后，从这384篇文章中选择了7篇进行分析。使用Cochrane偏倚风险评估工具评估偏倚风险。已提供结果的叙述性综合分析。
与标准腹腔镜手术方法相比，机器人辅助手术治疗大型食管旁疝在降低中转率和缩短住院时间方面可能具有优势。一些研究发现食管延长手术需求减少，长期复发率降低。大多数研究中，两种技术的围手术期并发症发生率相似；然而，一项在机器人技术应用早期对近170,000名患者进行的大型研究表明，机器人手术组食管穿孔和呼吸衰竭的发生率较高（绝对风险增加2.2%）。与腹腔镜修补术相比，机器人修补术的另一个缺点是费用较高。我们的研究受到研究的非随机和回顾性性质的限制。
需要更多关于复发率和长期并发症的研究来确定机器人辅助与腹腔镜下食管旁疝修补术的疗效。
